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To cite this article: Girija Kaimal, Kendra Ray & Juan Muniz (2016) Reduction of Cortisol
Levels and Participants' Responses Following Art Making, Art Therapy, 33:2, 74-80, DOI:
10.1080/07421656.2016.1166832
The data from cortisol levels and participant demo- 25.00 ng/ml to 5.01 ng/ml at posttest. See Figure 1 for
graphics were entered into an Excel file and imported for the changes in mean cortisol levels before and after art
analysis into SPSS. The data were first summarized using making.
descriptive statistics. Next, the mean pretest and posttest As can be seen in Figure 1, the mean cortisol levels
data cortisol values were compared using a paired samples t were significantly lower after art making, even though
test. The changes in cortisol levels were also examined in the change was not consistent across participants. The
relation to participants’ self-reported levels of expertise with levels were lowered more for some than for others. The
art making and media choice using a one-way ANOVA. An area graph in Figure 2 reveals the changes in cortisol
independent t test was performed to compare changes in levels as they varied across all participants. The pretest
cortisol based on gender. Correlations were also computed and posttest levels were, however, strongly correlated, r
to assess changes related to age of participants and time of D 0.61, p < .001. This indicates that overall those with
day. higher pretest cortisol levels had higher posttest scores
The written responses were compiled in response to the and similarly those with lower pretest scores also had
question, “What was it like to make art during this session?” lower posttest scores. Overall, the cortisol levels were
These were collected and entered into a textual document lowered after art making for approximately 75% of the
and analyzed using Riessman’s (2008) method for thematic sample. Cortisol levels stayed unchanged or were ele-
analysis. The narratives were coded independently for open vated for about 25%. Figure 3 highlights this range in
codes by the first and second authors. The codes generated change of cortisol levels with an area graph showing
were compared and those that were similar were combined. changes across all participants.
Those that differed were resolved through discussion and As can be seen in Figures 2 and 3, there was consider-
combined into a mutually agreed upon set of codes. The able variation across participants even though the overall
first and second authors then coded the responses again and results indicated a statistically significant reduction in
identified seven distinct themes. Once the responses were
coded, each theme was attributed a dichotomous numerical
value (1 D theme present or 0 D theme not present) for
each participant. The qualitative responses were thus con-
verted into numeric data and then entered into the quanti-
tative database to examine how and to what extent the
narrative responses related to changes in cortisol levels.
Results
Changes in participants’ pretest/posttest stress levels
were measured via salivary cortisol (measured in nano-
grams/milliliter). A paired-sample t test indicated signifi-
cant reductions in cortisol following the intervention.
Mean scores for cortisol levels pretest (M D 17.85, SD D
5.11) and posttest (M D 14.77, SD D 5.06), t(38) D
4.54, p < .01, differed significantly. Cortisol levels ranged Figure 2. Individual Salivary Cortisol Levels Before (Dark
from 32.40 ng/ml to 5.05 ng/ml at pretest and from Grey) and After (Light Grey) Art Making
KAIMAL / RAY / MUNIZ 77
Gender
Age
healthy adults as a result of art making in a format struc- might also consider assessing levels of salivary alpha amy-
tured to be similar to an art therapy session. We also exam- lase, a biomarker increasingly being considered a more
ined participants’ written responses to the experience, which accurate measure of short-term changes in stress levels
allowed for a more complete understanding of its impact. (Nater & Rohleder, 2009). Further research is also needed
Written responses indicated that some themes (evolving pro- to better understand the differences in outcomes between
cess and learning about self) were associated with greater psychological and physiological measures, differences
lowering of cortisol than other themes, though the correla- related to type of media, differences in outcomes based on
tions were weak. These results have to be viewed with cau- art making with and without an art therapist, and differen-
tion because of this, together with the small sample size. ces with clinical populations.
Art making is an enjoyable or relaxing experience for There are several limitations of this study to consider.
some, whereas for others it is associated with freedom of The primary limitation was the absence of a control group.
expression, evokes a flow experience, stimulates insight, and Thus it is hard to determine at present which factors in the
provides a way to learn about one’s self. Further research is session (art making, interactions with the researcher, or
needed to better understand how these experiences are something else) contributed to the lowering of cortisol.
related to changes in cortisol levels and stress reduction. Moreover, participants varied in their level of interaction
Although results overall were statistically significant, with the researcher and need for structure during art mak-
reductions in cortisol levels were not consistent for all partici- ing, which again made each experience somewhat variable.
pants. Levels were lowered for about 75% of the sample The study also used a healthy (nonclinical) sample and thus
(n D 30). This does not seem to have been related to the it is not clear if the same patterns would be seen in clinical
type of media used or to gender. There was a weak correla- groups. In many of the between-group analyses, the sub-
tion with age such that younger participants demonstrated a groups were not very large. Therefore results in these cases
greater lowering of cortisol than older participants. This must be interpreted with caution. Lastly, 85% of the partic-
might be because older individuals may have a more prac- ipants were women and nearly 80% had moderate to high
ticed response to their stress levels and are able to tap into levels of experience with art making, which further limits
problem-solving strategies more readily compared with youn- the generalizability of the findings.
ger individuals. In addition, lowering of cortisol levels was Our pilot study provides preliminary evidence for the
more likely to be seen earlier in the day, rather than later, use of art making for lowering cortisol, a proxy measure of
which has implications for the timing of studies of these stress, among healthy adults. To the best of our knowledge
kinds of interventions, as well as for patient interventions. this is the first study to demonstrate lowering of cortisol lev-
It is of note that for a little less than 25% of the sample els after a short session of art making structured to be simi-
(n D 9), cortisol levels stayed about the same or actually lar to an art therapy situation. In our sample, reduction of
went up by a few ng/ml after art making. The narrative cortisol was not related to gender, type of media used, race/
responses of these individuals did not indicate any negative ethnicity, or prior experience with art making, although it
reflections about the art-making process. This finding raises was related slightly to age and time of day. There were
several questions. It could be that art making resulted in a weak to moderate correlations between the lowering of cor-
state of arousal and/or engagement, which resulted in tisol and the narrative response themes of learning about
higher stress for this small group. This might not necessarily self and the evolving process of art making. It is of note that
be a problem, because arousal may lead to increased self- cortisol levels were lowered for most participants but not
awareness or new learning. In fact, we did find some corre- all, indicating a need to further explore stress reduction
lations between changes in cortisol and participants’ narra- mechanisms.
tive experiences. Those who spoke about an evolving
process from initial struggle to later resolution and those
who reported learning about self were slightly more likely Funding
to demonstrate a decrease in cortisol. It is also possible that
45 minutes of art making was not adequate time for some This study was funded through a grant to the first author
to experience reduced stress or notice any benefits. In addi- from the Office of Faculty Development and Equity at
tion, for a few participants, the art making was possibly Drexel University.
stressful and/or stimulating; and as a result, their cortisol
went up instead of down even though their narrative
response suggested a positive experience. It is also possible References
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